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Treatment of eosinophlic esophagitis with swallowed topical corticosteroids

World Journal of Gastroenterology 2020年第36期26卷 5395-5407页

作者： simon nennstiel Christoph Schlag Klinikum rechts der Isar der Technischen Universität München Klinik und Poliklinik für Innere Medizin IIMunich 81675Germany

Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the *** proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a first line therapy according to current *** review describes the background and practical management of STCs in *** far,mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications“off label”.Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85%-an orodispersible tablet of budesonide has been approved as the first“in label”medication for EoE in Europe in June *** it was shown that disease remission induction of EoE by STCs is highly effective,there is still a lack of data regarding long-term and maintenance ***,current studies on STC maintenance therapy add some movement into the game.

关键词： Eosinophilic esophagitis Swallowed topical corticosteroids Esophagustargeted formulations of topical steroids Fluticasone Budesonide Budesonide orodispersible tablet Budesonide oral suspension

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Management of occluded self-expanding biliary metal stents in malignant biliary disease

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 49-54页

作者： simon nennstiel Isolde Tschurtschenthaler Bruno Neu Hana Algül Monther Bajbouj Roland M. Schmid Stefan von Delius Andreas Weber Klinik und Poliklinik fur Innere Medizin Ⅱ Klinikum rechts der Isar der Technischen Universitar Manchen Ismaninger Straβe 22 Munich 81675 Germany Medizinische Klinik II Krankenhaus Landshut-Achdorf Academic Teaching Hospital Technische Universitar Munchen Achdorferweg 3 Landshut 84036Germany

Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of ***: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case ***: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management

关键词： Self-expanding metal stents Biliary tract neoplasms Endoscopic retrograde cholangiopancreatography Biliary tract diseases Complications

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Positive predictors for gastroesophageal reflux disease and the therapeutic response to proton-pump inhibitors

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World Journal of Gastroenterology 2014年第14期20卷 4017-4024页

作者： Valentin Becker Stefan Grotz Christoph Schlag simon nennstiel Analena Beitz Bernhard Haller Roland M Schmid Alexander Meining Monther Bajbouj Ⅱ. Medizinische Klinik und Poliklinik Technische Universit?t München Institut für Medizinische Statistik und Epidemiologie Technische Universit?t München

AIM:To identify objective and subjective predictors for the reliable diagnosis of gastroesophageal reflux disease(GERD)and the response to proton pump inhibitor(PPI)***:Retrospectively,683 consecutive patients suspected for GERD who underwent pH-metry/impedance measurement(pH/MII)were *** patients had previously undergone standard PPI treatment(e.g.,pantoprazole 40 mg/d or comparable).Four hundred sixty patients were at least 10 d off PPIs(group A),whereas 223 patients were analyzed during their ongoing PPI therapy(group B).In addition,all patients completed a standardized symptom-and lifestyle-based questionnaire,including the therapeutic response to previous PPI trials on a 10-point *** multivariance analyses were performed to identify criteria associated with positive therapeutic response to ***:In group A,positive predictors(PPs)for response in empirical PPI trials were typical GERD symptoms(heartburn and regurgitation),a positive symptom index(SI)and pathological results in pH/MII,along with atypical symptoms,including hoarseness and *** group B,regular alcohol consumption was associated with the therapeutic *** PPs for pathological results in pH/MII in group A included positive SI,male gender,obesity,heartburn and *** group B,the PPs were positive SI and *** for positive SI,the PPs were pathological pH and/or MII,heartburn regurgitation,fullness,nausea and vomiting in group A and pathological pH and/or MII in group ***:Anamnestic parameters(gender,obesity,alcohol)can predict PPI *** non-obese,female patients with non-typical reflux symptoms,pH/MII should be considered instead of empirical PPIs.

关键词： Gastroesophageal reflux Gastroesophageal reflux di

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New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal p H metry in extraesophageal gastroesophageal reflux disease

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World Journal of Gastroenterology 2015年第3期21卷 982-987页

作者： Valentin Becker Romina Drabner simone Graf Christoph Schlag simon nennstiel Anna Maria Buchberger Roland M Schmid Dieter Saur Monther Bajbouj Ⅱ.Medizinische Klinik Klinikum rechts der IsarTechnische Universit?t München81675 MünchenGermany Hals-Nasen Ohren Klinik Klinikum rechts der IsarTechnische Universit?t München81675 MünchenGermany

AIM:To determine the laryngeal H+K+-ATPase and pharyngeal p H in patients with laryngopharyngeal reflux(LPR)-symptoms as well as to assess the symptom scores during PPI ***:Endoscopy was performed to exclude neoplasia and to collect biopsies from the posterior cricoid area(immunohistochemistry and PCR analysis).Immunohistochemical staining was performed with monoclonal mouse antibodies against human H+K+-*** real-time RT-PCR for each of the H+K+-ATPase subunits was *** p H values were assessed in the aerosolized environment of the oropharynx(Dxp H Catheter) and compared to a subsequently applied combined p H/MII ***:Twenty patients with LPR symptoms were *** only one patient,the laryngeal H+K+-ATPase was verified by immunohistochemical *** another patient,real-time RT-PCR for each H+K+-ATPase subunit was *** out of twenty patients had pathological results in Dxp H,and 6/20 patients had pathological results in p H/*** patients had pathological results in both functional *** out of twenty patients responded to ***:The laryngeal H+K+-ATPase can only be sporadically detected in patients with LPR symptoms and is unlikely to cause the LPR *** hypotheses for the pathomechanism are *** role of pharyngeal p H-metry remains unclearand its use can only be recommended for patients in a research study setting.

关键词： Laryngopharyngeal reflux Proton pump inhibitor Gas

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